Orbital wall fractures. Conventional views and CT.

In order to evaluate the benefit derived by conventional views in the initial diagnosis of fractures of the orbital walls, a clinical study was designed to compare the results of evaluations by plain films and coronal CT scans. The conventional Caldwell's and Waters' views will provide a fairly reliable result as to the presence of orbital fractures: orbital floor (anterior in 78%, posterior in 73%), medial orbital wall (anterior in 71%, posterior in 72%), and ethmoid-maxillary plate in 64%. False-negative diagnosis was seen at the anterior portion of the floor in 13%, at the anterior portion of the medial orbital wall in 7%, and at the ethmoid-maxillary plate in 11%. False-negative diagnosis was seen at the orbital floor (anterior in 9%, posterior in 10%), at the medial orbital wall (anterior in 21%, posterior in 29%), and at the ethmoid-maxillary plate in 21%. Our results agree well with those of the past reports.

[Endoscopic sinus surgery for unilateral chronic sinusitis].

Functional endoscopic sinus surgery has become an increasingly popular treatment for chronic sinusitis. This approach is aimed at re-establishment of ventilation and mucociliary clearance of the sinuses. However, some otolaryngologists believe that the Caldwell-Luc procedure should be routinely used for unilateral chronic sinusitis, because it is often associated with the maxillary sinus carcinomas. To evaluate the state of endoscopic sinus surgery for the diagnosis and treatment of unilateral chronic sinusitis, we analyzed the cases of 39 patients with unilateral chronic sinusitis who underwent endoscopic sinus procedures. These patients were unresponsive to appropriate antibiotic management for more than 6 months. Generally, endoscopic ethmoidectomy and antrostomy were performed with preservation of the middle turbinate. After the ostium was enlarged, the maxillary sinus was cleaned and carefully inspected for the presence of associated neoplasms using 30 and 70 degree endoscopes. Preoperative computed tomography (CT), postoperatve pathologic diagnosis, fiberscopic findings of the maxillary sinus, and symptomatic improvement were evaluated. Three patients had CT evidence of bone destruction of the lateral nasal wall. Pathological diagnosis demonstrated that three patients had maxillary sinus mycoses caused by Aspergillus species, one patient had inverted papilloma, and the other 35 patients had chronic sinusits. No associated malignancy was found. Eighty-one percent of the patients had almost normal endoscopic findings of the maxillary sinus by postoperative fiberscopic examination 4 to 8 months following surgery. With an average follow-up of 26 months, 88% of the patients were judged as having significantly improved in their presenting complaints of mucopurulent rhinorrhea, nasal obstruction, and facial pain. The results of this series suggest that endoscopic sinus surgery is an effective procedure for the diagnosis and treatment of unilateral chronic sinusitis.

[Orbital wall fractures: a comparison of computed tomography and conventional views].

A total of 59 cases of mild facial fractures (simple orbital wall fractures, 34 cases, other facial fractures, 25 cases) with the clinical suspects of orbital wall fractures were evaluated both by conventional views (Waters' and Caldwell views) and coronal CT scans. Conventional views were obtained, as an average, after 4 days and CT after 7 days of injuries. Both the medial wall and the floor were evaluated at two sites, i.e., anterior and posterior. The ethmoid-maxillary plate was also included in the study. The degree of fractures was classified as, no fractures, fractures of discontinuity, dislocation and fragmentation. The coronal CT images in bone window condition was used as reference and the findings were compared between conventional views and CT. The correct diagnosis was obtained as follows: orbital floor (anterior, 78%, posterior, 73%), medial orbital wall (anterior, 72%, posterior, 72%) and ethmoid-maxillary plate (64%). The false positive diagnosis was as follows: orbital floor (anterior only, 13%), medial orbital wall (anterior only, 7%) and ethmoid-maxillary plate (11%). The false negative diagnosis was as follows: orbital floor (anterior, 9%, posterior, 10%), medial orbital wall (anterior, 21%, posterior, 28%) and ethmoid-maxillary plate (21%). The results were compared with those of others in the past.

[A case report of lymphoepithelial cyst in the parotid gland].

A 57 year-old Japanese male was seen with the chief complaints of left parotid gland swelling, pain, trismus. At the initial visit, a subcutaneous mass, measuring 50 x 70mm, was seen in the left parotid region. The mass was moderately tender and the consistency was soft anteriorly and elastic firm posteriorly. The mobility was restricted with no change in the skin covering the mass. The saliva from the left parotid gland was normal in colour and contents. Various imaging modalities were done preoperatively including CT, MRI, ultrasonography and aspiration biopsy under the ultrasonographic guide. None was thus conclusive for the differential diagnosis and our tentative diagnosis was a cystic lesion in the parotid gland. A partial parotidectomy was performed under general anesthesia and the cystic lesion, measuring 20mm in diameter, was found in the deep lobe. The cyst showed no connection to the external ear canal, and tracts and fistulae were absent. Histopathological report lead to the definite diagnosis of lymphoepithelial cyst. A mild and incomplete facial palsy on the left had been noted for more than 10 years and this, however, improved after the surgery.

[Blow-out fractures of the orbit--imaging modalities and therapeutic results].

Thirty-four cases of blow-out fracture were evaluated by high-resolution CT, Hess test for red and green color and synoptophore. The results of these tests were compared with the final outcome of the fractures. The fractures were classified on the basis of the location (floor, medial wall or roof), extent (total, partial or linear) and type of fragments (punched-out or trapdoor). The medial wall type included many cases (33%) with no complaint of double vision, and many cases with a combination of disturbances in ocular mobility in both the horizontal and vertical directions. The floor type showed a low incidence of disturbances in ocular movement in the horizontal directions. Regarding the extent of the fracture, all cases with the total type showed disappearance of double vision within three months. Many of the partial and linear types had a poor outcome. With regard to the type of fragments, all of the trapdoor type cases showed a favorable result with disappearance of double vision within three months. Some of the punched-out type cases, however, showed a poor outcome.

[On the postoperative mucocele of the maxillary sinus and its simulating cases. A clinical treatise].

The postoperative mucocele of the maxillary sinus typically occurs after 11-15 years after the initial Caldwell-Luc operation with the complaints of swollen and painful cheek. Typical signs and symptoms will be divided into two groups, the one which is associated with expansive lesions and the other with pains along the various branches of the maxillary nerve. In the clinical set-ups, cases with the similar signs and symptoms, and yet lacking definite mucoceles, are often encountered. The present treatise will compare 86 definite cases and 27 simulating cases as to the history, signs and symptoms, various modalities of imaging (CT & MRI), and the possible causes leading to simulating cases. The age at onset, gender, affected side, and period after the initial sinus surgery all showed no differences between the two, i.e., definite and simulating cases. Among signs and symptoms, the definite case showed more of swelling-related matters whereas the simulating case more of pain-related except toothache. The past history of surgeries for the mucoceles on the similar sides to the present lesion is more often seen in the simulating case (64.3%) than in the definite case (18.3%). The findings by imagings in the simulating cases are as follows; obliterated sinus (25.0%), healthy, aerated postop. cavity (35.7%), postop. cavity with mucosal thickening (32.1%), and cyst-like aerated cavity (7.1%). The possible causes leading to the simulating cases are as follows; causes unknown (39.3%), recurrent infection in the postop. cavity (28.6%), dental origin (10.7%), atypical neuralgia (10.7%) and the case shortly after the proceeding sinus surgery (within 12 months, 10.7%).(ABSTRACT TRUNCATED AT 250 WORDS)